State Health Lawmakers' Digest: Racial and Ethnic Disparities (Vol. 2, No. 4), Cover Story

INTRODUCTION

Racial and Ethnic Disparities in Health Care

During the last several decades, the health of the American population has generally improved. Since 1950, the overall infant mortality rate has declined from 29.2 per thousand to 7.1 per 1,000, while life expectancy has increased from 68.2 years to 76.7 years. Although these improvements cut across racial and ethnic groups, a marked gap remains between whites and minorities. Life expectancy among whites, for example, increased from 69.1 years to 77.3 years, while the improvement among blacks was only from 60.8 years to 71.4 years.

Research shows that members of ethnic and racial minorities are less likely to receive routine medical procedures, suffer from more preventable conditions compared to their non-Hispanic white counterparts, and tend to receive lower quality care. Compared to whites, African Americans and Hispanics are less likely to receive appropriate cardiac medications, undergo cardiac bypass surgery or receive hemodialysis and kidney transplantation and are more likely to receive lower quality clinical services, even when factors such as insurance status, age, income, co-morbid conditions and symptomatolgy are taken into account.

Disparate Coverage

What contributes to this difference? Perhaps the most obvious link to disparate access is insurance coverage. Minority Americans are twice as likely to be uninsured as whites, with Latinos being most likely to be uninsured (1 in 3 Latinos report they have no health insurance coverage). Adults without health insurance are less likely to receive appropriate preventive, chronic and acute care services and are more likely to have poorer health and die prematurely than are their insured counterparts. Research shows that uninsured patients with colon or breast cancer are 50 percent more likely to die than are their insured counterparts.

Although health insurance may alleviate the financial barriers to care, it does not address other individual and societal determinants-such as low literacy skills, health beliefs, life-style practices and environmental influences-of poor health and disparate care that are experienced by ethnic minorities and the economically disadvantaged. Low educational attainment, poverty and economic hardship are associated with high rates of infectious diseases, chronic conditions, self-reported self-health, disability and lower life expectancy.

Disparate Process

Even at the same income and insurance levels, however, various groups experience a range of other barriers to care, including language, geography and cultural familiarity. Results from the Commonwealth Fund survey (see abstracts) show that African Americans, Asian Americans and Hispanics are more likely than whites to experience difficulties in communicating with their physicians and feel that they are treated with disrespect when receiving care. Moreover, minorities believe that the quality of their care is compromised because of their racial status.

Federal and State Agendas

In 1984, the U.S. Department of Health and Human Services released a report on the health of the nation, concluding that major disparities existed " ... in the burden of death and illness experienced by Blacks and other minority Americans" compared to the rest of the nation. In response, the Department of Health and Human Services, for the first time, established a task force to examine minority health problems. As a result of the task force findings, the Office of Minority Health was established to address minority health issues through a network of federal, state and territorial offices of minority health.

The Minority Health and Health Disparities Research and Education Act of 2000 created a new center on minority health at the National Institutes of Health and expanded research and demonstration projects at the Agency for Health Care Research and Quality and the Health Services Resources Administration. In addition, Healthy People 2010 includes the explicit goal of eliminating racial and ethnic disparities in health and access to health care by the year 2010, focusing on targeted areas such as infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, and immunizations.

Racial disparities recently have received renewed attention. State activities center on revitalizing offices of minority health, building programs to address disparities in the conditions identified in Healthy People 2010, and Medicaid contracting that addresses disparate outcomes. More details on these actions can be found in this digest in "On the Horizon" and "What Works."

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